Association of Financial Strain With Symptom Burden and Quality of Life for Patients With Lung or Colorectal Cancer

Abstract

Purpose: To measure the association between patient financial strain and symptom burden and quality of life (QOL) for patients with new diagnoses of lung or colorectal cancer.

Patients and methods: Patients participating in the Cancer Care Outcomes Research and Surveillance study were interviewed about their financial reserves, QOL, and symptom burden at 4 months of diagnosis and, for survivors, at 12 months of diagnosis. We assessed the association of patient-reported financial reserves with patient-reported outcomes including the Brief Pain Inventory, symptom burden on the basis of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30, and QOL on the basis of the EuroQoL-5 Dimension scale. Multivariable linear regression models were fit for each outcome and cancer type, adjusting for age, race/ethnicity, sex, income, insurance, stage at diagnosis, and comorbidity.

Results: Among patients with lung and colorectal cancer, 40% and 33%, respectively, reported limited financial reserves (≤ 2 months). Relative to patients with more than 12 months of financial reserves, those with limited financial reserves reported significantly increased pain (adjusted mean difference, 5.03 [95% CI, 3.29 to 7.22] and 3.45 [95% CI, 1.25 to 5.66], respectively, for lung and colorectal), greater symptom burden (5.25 [95% CI, 3.29 to .22] and 5.31 [95% CI, 3.58 to 7.04]), and poorer QOL (4.70 [95% CI, 2.82 to 6.58] and 5.22 [95% CI, 3.61 to 6.82]). With decreasing financial reserves, a clear dose-response relationship was present across all measures of well-being. These associations were also manifest for survivors reporting outcomes again at 1 year and persisted after adjustment for stage, comorbidity, insurance, and other clinical attributes.

Conclusion: Patients with cancer and limited financial reserves are more likely to have higher symptom burden and decreased QOL. Assessment of financial reserves may help identify patients who need intensive support.

Fig 1.

Flow diagram. *Subgroup with patient-reported quality of life, symptom burden, and physical function at baseline; †It was possible for patients to have completed the follow-up interview themselves, even when the baseline interview was completed by a surrogate. CanCORS, Cancer Care Outcomes Research and Surveillance.

Fig 2.

Unadjusted means of baseline patient-reported quality-of-life measures by financial strain and cancer type. All measures are presented such that lower scores represent worse outcomes. Error bars represent 95% CIs. *P for trend < .001 for the association between financial strain and all quality-of-life measures, within both diseases; †Brief Pain Inventory (BPI) and EORTC symptom index were inverted so that lower scores represent worse outcomes. EORTC, European Organisation for Research and Treatment of Cancer; EQ-5D, EuroQoL-5 Dimension; QLQ 30, Quality of Life Questionnaire C30; SF-12, 12-Item Short Form Health Survey.

Fig 3.

Unadjusted and adjusted differences in patient-reported quality-of-life measures according to financial reserves, from linear regression models. (A) Lung cancer. (B) Colorectal cancer. Differences are in reference to financial reserves of more than 1 year. Adjusted differences control for age, sex, race/ethnicity, household income, education, health insurance, stage, and comorbidity. *For all measures, unadjusted P < .001 and adjusted P < .02 for the overall F test of an association between financial reserves and quality of life; †BPI and EORTC symptom index were inverted so that lower scores represent worse outcomes. BPI, Brief Pain Inventory; EORTC, European Organisation for Research and Treatment of Cancer; EQ-5D, EuroQoL-5 Dimension; SF-12, 12-Item Short Form Health Survey.

Fig 4.

Unadjusted and adjusted differences in patient-reported quality-of-life measures at the time of the follow-up survey according to financial reserves, from ordinal logistic regression. (A) Lung cancer. (B) Colorectal cancer. Differences are in reference to financial reserves of more than 1 year. Adjusted differences control for age, sex, race/ethnicity, household income, education, health insurance, stage, and comorbidity. *Overall F test of an association between financial reserves and quality of life: (1) unadjusted P < .001 for all measures and both cancer types, (2) lung: adjusted P = .13 for general health and adjusted P < .02 for other three measures, and (3) colorectal: adjusted P = .16 for physical activity and adjusted P < .05 for other three measures.